NSAID Prescription Research Articles

OP0187-PC Potentially harmful prescription of NSAIDS in a primary care population with musculoskeletal complaints

BackgroundTo reduce adverse drug events (ADEs), clinical guidelines recommend cautious prescription of non-steroidal anti-inflammatory drugs (NSAIDs) in patients known to be at a high risk of developing a serious ADE....

OP0119 Great progress but much more needed: Hospitalizations due to complicated gastric and duodenal ulcers in the US (1990-2009)

BackgroundGastrointestinal bleeding, perforation, and obstruction of gastric (GU) and duodenal ulcers (DU) (collectively Peptic Ulcer Disease, PUD) are significant causes of hospitalizations and mortality in the US.ObjectivesTo examine hospitalizations due...

Variables associated with change in blood pressure control status after 1-year follow up in primary care: a retrospective analysis: the TAPAS study

This 1-year, retrospective, observational study assessed factors associated with changes in hypertension control status and differences in blood pressure (BP) management among general practitioners in Spain. In 2009, 307 investigators from 260 primary care centres in Spain recruited the first four consecutive patients with hypertension that fit into one of four predefined cohorts: (1) uncontrolled BP at baseline and at a 1-year follow-up visit; (2) uncontrolled BP at baseline and good BP control at the 1-year follow-up visit; (3) good BP control at baseline and loss of BP control at the 1-year follow-up visit; and (4) good BP control at baseline and at the 1-year follow-up visit. A total of 1385 patients were included. Patients with poor BP and patients that lost BP control exhibited more cardiovascular risk factors. Although antihypertensive treatment was increased more markedly in these patients, this was not sufficient to attain/remain BP goals. Predictors for attaining BP control were no smoking, absence of diabetes, reduction in cholesterol, low baseline cholesterol, and no weight gain. Predictors for failing to maintain BP goals were weight gain, high baseline LDL cholesterol, and no reduction in fasting glucose. NSAID prescriptions increased markedly in patients that lost BP control compared to those that maintained BP control. Antihypertensive therapy should be intensified and healthy lifestyle changes should be emphasized, particularly weight control to improve BP control. Drugs that may increase BP levels, such as NSAIDs, should also be avoided.

GRP-071 Evaluation of the Prescription of Intravenous Non-Steroidal Anti-Inflammatory Drugs Compared to the Recommendations of the Summary of Product Characteristics

BackgroundAcute renal failure is a side effect of NSAIDs.Purpose To assess the appropriateness of the intravenous prescription of dexketoprofen according to the dosage specifications depending on renal function following the...

Factors Associated with Gastroprotective Agent Use and Adherence among Adults with Arthritis Taking NSAIDs in the United States

Purpose: To examine factors associated with gastroprotective agent (GPA) use and adherence among adults with arthritis taking NSAIDs. Methods: A Web-based community panel of US men and women age ≥40 with self-reported arthritis was invited via e-mail to participate in a Web survey. Interested panelists consented and completed the screening questions. Respondents who reported NSAID use in the last 30 days were eligible to continue the survey. NSAID and GPA use were asked, as were questions about comorbid conditions, gastrointestinal (GI) history, and other risk factors. Logistic regressions were performed to assess the associations of predictor variables with GPA use and adherence. Results: Invitations were sent to 7,605 adults with arthritis; 4,108 (54%) responded; 2,208 completed. The final sample consisted of 2,000 participants: 1,525 (76%) with osteoarthritis, 354 (18%) with rheumatoid arthritis and 121 (6%) with both. Mean age was 62.0 years; 64% were female; 83% were white; 25% worked full-time and 39% were retired. Mean duration with arthritis was 13.0 years; 47% and 19% experienced arthritis symptoms “daily” and “almost always”, respectively. The most frequently-used NSAIDs were ibuprofen (54%), aspirin (35%) and naproxen (33%). GPA use was more frequent among higher frequency NSAID users; 36% of single NSAID users and 43% of participants taking 4+ NSAIDs reported taking GPAs. The most frequently-used GPAs were omeprazole (48%), esomeprazole (17%), and ranitidine (17%); 39% of daily NSAID users reported taking a GPA. Variables significantly associated with GPA use were: older age (odds ratio (OR) 1.02); male gender (OR 0.76); being white (vs. Hispanic) (OR 0.24); taking an NSAID at least daily (OR 1.5 for daily use; 2.2 for 2x daily use; and 1.8 for use ≥ 3 times per day); taking fewer NSAIDs (OR 0.83); taking a COX-2 inhibitor (OR 1.6) or a prescription NSAID (OR 1.9); history of ulcer (OR 2.2), Barrett's esophagus (OR 8.8), or GERD (OR 12.6); prescription antiplatelet use (OR 1.9); and more frequent GI symptoms as indicated by GSRS total score (OR 1.5). Variables significantly associated with GPA adherence were: (OR 1.02); inflammatory bowel disease (OR 1.57); GERD (OR 1.72); less frequent GI symptoms (OR 0.62); prescription antiplatelet use (OR 1.97); and prescription NSAID use (OR 1.65). Conclusion: Slightly more than 1/3 of daily NSAID users routinely take GPAs. Older age; taking a prescription NSAID; history of GERD; prescription antiplatelet use; and GI symptoms were all associated with GPA use and adherence to GPA regimen in this sample of adults with arthritis using NSAIDs. These data may be useful for clinicians treating patients with arthritis. Disclosure: Karin S. Coyne, Mary Kay Margolis, and Ray Hsieh are employees of United BioSource Corporation who were paid scientific consultants to Pfizer in connection with this research. Joseph C. Cappelleri, Margaret Noyes Essex, Peter W. Park and Ashish V. Joshi are employees and stockholders of Pfizer Inc. This study was funded by Pfizer Inc. This research was supported by an industry grant from Pfizer Inc.

Study protocol of a mixed-methods evaluation of a cluster randomized trial to improve the safety of NSAID and antiplatelet prescribing: data-driven quality improvement in primary care

BackgroundTrials of complex interventions are criticized for being ‘black box’, so the UK Medical Research Council recommends carrying out a process evaluation to explain the trial findings. We believe it is good practice to pre-specify and publish process evaluation protocols to set standards and minimize bias. Unlike protocols for trials, little guidance or standards exist for the reporting of process evaluations. This paper presents the mixed-method process evaluation protocol of a cluster randomized trial, drawing on a framework designed by the authors.Methods/designThis mixed-method evaluation is based on four research questions and maps data collection to a logic model of how the data-driven quality improvement in primary care (DQIP) intervention is expected to work. Data collection will be predominately by qualitative case studies in eight to ten of the trial practices, focus groups with patients affected by the intervention and quantitative analysis of routine practice data, trial outcome and questionnaire data and data from the DQIP intervention.DiscussionWe believe that pre-specifying the intentions of a process evaluation can help to minimize bias arising from potentially misleading post-hoc analysis. We recognize it is also important to retain flexibility to examine the unexpected and the unintended. From that perspective, a mixed-methods evaluation allows the combination of exploratory and flexible qualitative work, and more pre-specified quantitative analysis, with each method contributing to the design, implementation and interpretation of the other.As well as strengthening the study the authors hope to stimulate discussion among their academic colleagues about publishing protocols for evaluations of randomized trials of complex interventions.Data-driven quality improvement in primary care trial registrationClinicalTrials.gov: NCT01425502

Longitudinal changes in prescription use in the osteoarthritis initiative (OAI)

Purpose: To investigate the longitudinal changes in prescription use in the OAI study Methods: 48 month medication data were added to data collected for previous clinic visits of the OAI study. The data were sorted by drug classes with particular focus on NSAIDS, Statins and Bisphosphonates, chosen for their association with musculoskeletal diseases. Chi-squared statistics were used to compare groups at baseline and 48 months. Results: There was an overall decrease in the number of prescriptions for both NSAIDs and Bisphosphonates from baseline to 48 months (by 48% (P<0.001) and 37 % (P=0.264) respectively), however the number of prescriptions for Statins increased by 58 % from baseline to 48 months (P<0.001) (Figure 1). Analysis showed there were significant differences between prescribing patterns by sex. Statin prescriptions for men and women increased significantly between baseline and 48 months (P<0.001) but NSAID prescriptions decreased significantly only in women at 48 months compared with baseline for females (P<0.001). The decrease in Bisphosphonate prescriptions from baseline to 48 months were not significant in females (P=0.59) or males (P=0.062). The differences between cohorts were analysed at each time point and each of the three drug classes showed significant differences (P<0.001). Subset analysis, however, found that both NSAIDs and Bisphosphonates were significantly lower in the progression than the incident cohort (both P0.05). Conclusions: Over the duration of the OAI study the number of Statin prescriptions has significantly increased, whilst NSAID and Bisphosphonate prescriptions have decreased. The increase in Statin prescriptions is likely to be due to two factors, the increase in prescribing these drugs to a normal population for prevention of disease and an aging population. The decrease in the numbers of Bisphosphonate prescriptions may be attributable to patients having a drug holiday, although we do not know for how long the patients have been on Bisphosphonates prior to study entry. These temporal changes in prescription drug use should be borne in mind when analysing the OAI dataset.

Analysis of potential interactions between warfarin and prescriptions in Estonian outpatients aged 50 years or more

In Estonia, warfarin is widely prescribed by general practitioners to prevent and treat thromboembolic diseases. To date, there has been no systematic analysis of the potential risk of warfarin interactions with other drugs in the outpatient population. The aim of the study was to analyze the incidence of potential interactions in prescription schemes in Estonia in a cohort of outpatients receiving warfarin treatment. The retrospective study population included 203,646 outpatients aged 50 years or older of whom 7,175 received warfarin therapy. Patients who had used at least one prescription drug for a minimum period of 7 days concomitantly with warfarin were analyzed. Potential drug interactions were analyzed using Epocrates online, Stockley's Drug Interactions and domestic drug interaction databases. The average number of drugs used concomitantly with warfarin was 4.8 (SD=1.9) (males: 4.7 SD=2.0, females: 4.9 SD=2.0). No potential interactions in treatment regimens were found in 38% of patients, one potential interaction was observed in 29% and two or more potential interactions were observed in 33% of patients. The mean number of all potential interactions was 1.2 per patient and about the same in men and women. Potential interactions were associated with the number of drugs. Warfarin-related interactions were detected in 57% of patients, and the number of interactions related to warfarin per patient varied from 1 to 5. Most frequent were use of warfarin with NSAIDs (14%), followed by simvastatin (9%) and amiodarone (7%). This study shows that 57% of outpatients in Estonia receiving warfarin have drugs potentially interacting with warfarin in their treatment schemes. Most interactions (14%) with warfarin are associated with the prescription of NSAIDs.

PREDICTORS OF THE USE OF GASTROPROTECTIVE AGENTS IN PATIENTS USING NSAID IN YOGYAKARTA INDONESIA

Non Steroid Anti-Inflammatory (NSAID) is one type of AntiInflammatory drug that is used to treat pain in patients of osteoarthritis (OA) and rheumatoid arthritis (RA). The use of NSAIDs can cause gastrointestinal side effects. To prevent the side effects, NSAIDs are prescribed in combination with gastroprotective agent (GPA). The aim of the study is to determine the factors considered in the GPA prescription by the doctors in patients who have risk factors for gastric disorder due to NSAIDs use. This study was performed using a cross-sectional observational design. The data were collected retrospectively during a period of January to December 2010. The subjects were OA and RA patients considering the inclusion and exclusion criteria. The data included patient characteristics (gender, age, occupation, payment method, the primary diagnosis), prescription of NSAID, prescription of GPA, history of gastrointestinal disease, NSAID prescription with corticosteroids, prescription with antiplatelet. The data were processed descriptively and quantitatively, and analyzed statistically using chi-square and log. regression with 95% Confidence Interval. The results showed that there were correlation between some predictor factors with prescription of gastroprotective agent. These factors were women patient, patient age of ≥ 65 years, oxicam prescribing, diclofenac sodium prescribing, prescribing >1 type of NSAIDs, prescription of NSAID concomitant with corticosteroids, prescription of NSAID concomitant with antiplatelet, patients with history of gastrointestinal, prescribing NSAIDs with duration of ≥ 3 months. Patient with a history of gastrointestinal disease was the most predictor influential factor, with OR (odds ratio) of 3.6 (95% CI: 2.79 - 4.66). Predictor factor of patients with a history of dyspepsia possessed the highest OR {OR=4,29 (CI 95%: 3.23–5.7)}. It means that patients with a history of dyspepsia prescribed NSAIDs would have greater risk of 4.29 times to get GPA prescription than patients without a history of dyspepsia. Prescribing NSAIDs > 1 DDD (defined daily dose) had p value of 0.777, which means there was no relationship between GPA prescription with NSAIDs > 1 DDD prescription. Key words: Gastroprotective Agent, Non-steroid anti-inflammatory, Osteoarthritis, Rheumatoid Arthritis

Renal function assessment in non-steroidal anti-inflammatory drug prescriptions. A pilot study in a primary care centre.

To determine the current state of renal function monitoring carried out on patients treated with NSAIDs. We selected patients from a Primary Care Centre who had received NSAIDs for the first time. We checked if renal function was measured and/or controlled 2 months pre/6 months post-NSAID administration in order to assess if patient renal function was known at the time of prescription and afterwards. During the study period, there were 42 822 prescriptions made. Of these, 8611 were new drug prescriptions, of which 482 (5.6%) were NSAIDs in patients older than 14 years of age. A total of 450 patients (64% female) were treated with NSAIDs. Ibuprofen (66.0%) was the most commonly prescribed. NSAIDs were more frequently used in patients between 14-45 years of age. Only 168 (37.1%) patients underwent any analytical tests over the course of the study (68% female). Before prescription, renal function was measured in only 14% of cases (63 patients). Two patients received NSAIDs despite having high serum creatinine levels. During the follow-up, serum creatinine was measured in 129 patients (28.7%). In primary care, NSAIDs represent a substantial percentage of the drugs prescribed (5.6%). Ibuprofen is the most commonly prescribed. NSAIDs are more frequently used in women between 14-45 years. Musculo-skeletal pain is the main indication for prescription. Only 14% of patients receiving these drugs had previously measured levels of serum creatinine. These values are rarely taken into account when prescribing NSAIDs. Control of renal function after NSAID prescription was unusual.

Differences between soft-disc herniation and spondylosis in cervical arthroplasty: CT-documented heterotopic ossification with minimum 2 years of follow-up

Cervical arthroplasty is a valid option for patients with single-level symptomatic cervical disc diseases causing neural tissue compression, but postoperative heterotopic ossification (HO) can limit the mobility of an artificial disc. In the present study the authors used CT scanning to assess HO formation, and they investigated differences in radiological and clinical outcomes in patients with either a soft-disc herniation or spondylosis who underwent cervical arthroplasty. Medical records, radiographs, and clinical evaluations of consecutive patients who underwent single-level cervical arthroplasty were reviewed. Arthroplasty was performed using the Bryan disc. The patients were divided into a soft-disc herniation group and a spondylosis group. Clinical outcomes were measured using the visual analog scale (VAS) for neck and arm pain and the Neck Disability Index (NDI), whereas HO grading was determined by studying CT scans. Radiological and clinical outcomes were analyzed, and the minimum follow-up duration was 24 months. Forty-seven consecutive patients underwent a single-level cervical arthroplasty. Forty patients (85.1%) had complete radiological evaluations and clinical follow-up of more than 2 years. Patients were divided into 1 of 2 groups: soft-disc herniation (16 cases) and the spondylosis group (24 cases). Their mean age was 45.51 ± 11.12 years. Sixteen patients (40%) were female. Patients in the soft-disc herniation group were younger than those in the spondylosis group, but the difference was not statistically significant (42.88 vs 47.26, p = 0.227). The mean follow-up duration was 38.83 ± 9.74 months. Sex, estimated blood loss, implant size, and perioperative NSAID prescription were not significantly different between the groups (p = 0.792, 0.267, 0.581, and 1.000, respectively). The soft-disc herniation group had significantly less HO formation than the spondylosis group (1 HO [6.25%] vs 14 Hos [58.33%], p = 0.001). Almost all artificial discs in both groups remained mobile (100% and 95.8%, p = 0.408). The clinical outcomes were not significantly different between the groups at all postoperative time points of evaluation, and clinical improvements were also similar. Clinical outcomes of single-level cervical arthroplasty for soft-disc herniation and spondylosis were similar 3 years after surgery. There was a significantly higher rate of HO formation in patients with spondylosis than in those with a soft-disc herniation. The mobility of the artificial disc is maintained, but the long-term effects of HO and its higher frequency in spondylotic cases warrant further investigation.

Tendencias en la hemorragia gastrointestinal en la Comunidad Valenciana (2000-2005). Relación con la venta de antiinflamatorios no esteroideos y supresores de ácido

Objective: To describe 2000-2005 time trends of prescription for NSAIDs, proton pump inhibitors (PPIs) and hospital admissions for gastrointestinal (GI) bleeding. Methods: Time series analysis of gastrointestinal (GI) bleeding admission and drugs’ Defined Daily Dose per 1000 people per day (DDD/1000/day) in the Region of Valencia, Spain, from January 2000 to December 2005. Results: Dispensation of NSAIDs went from 42.7 DDD/1000 people/day in 2000 to 58.3 DDD/1000 people/day in 2005. During the same period, dispensation of PPIs went from 26.3 DDD/1000 people/ day to 68.5 DDD/1000 people/day (both are statistically significant). The rate of hospitalisations for gastrointestinal bleeding during this period oscillated between 142 and 126 admission per 100 000 inhabitants/year. No year showed significant differences compared to 2000. Conclusion: A substantial increase in the NSAID use from 2000 to 2005 was not accompanied by changes in GI bleeding hospitalisation rates in Valencia, but GI bleeding rates continued to be high, suggesting a need to improve NSAIDs use.

Changing current practice – the prescribing of NSAIDs

AbstractIn the second half of 2007 the National Prescribing Centre provided an number of initiatives aimed at encouraging reviews of NSAID prescribing with regard to cardiovascular and gastrointestinal risk. The authors used this as an opportunity to evaluate the subsequent changes in prescribing. Copyright © 2011 Wiley Interface Ltd

P2-72 Impact of the introduction of selective COX-2 inhibitors on hospitalisation for gastric bleeding in Australia

BackgroundSelective COX-2 inhibitors (coxibs) have been shown to be advantageous for gastrointestinal safety in several large studies but whether this translates into fewer events at the population level is unclear.AimTo...

Acute tubulointerstitial nephritis

Acute tubulointerstitial nephritis (TIN) is a frequent cause of acute renal failure, characterised by the presence of inflammatory cell infiltrate in the interstitium of the kidney. Immuno-allergic reaction to certain medications, mainly non-steroidal anti-inflammatory drugs and antibiotics are by far the most important etiology for TIN today, but other situations such as infections, toxins, and vasculitis are known to induce TIN. Incidence of TIN is increasing, probably due to prescription habits and NSAID overuse, representing 3-7% of acute kidney injury in biopsies in children. Avoidance of the causal substance and rapid steroid therapy are hallmarks for patient care, but spontaneous initial recovery is very frequent and the general prognosis seems satisfactory. However, development of chronic TIN, without response to steroid or other immunosuppressive treatment, is possible. As the largest part of TIN is secondary to certain drugs, clear indications in particular for NSAID or antibiotics should be respected to reduce the number of TIN cases.

Gout treatment and comorbidities: a retrospective cohort study in a large US managed care population

BackgroundGout prevalence increased in recent years to become one of the most common causes of inflammatory arthritis in most industrialised countries. Comorbidities may affect the disease severity and treatment patterns. We describe the main characteristics of gout patients, gout-related treatment patterns and prevalent comorbidities in a managed care population.MethodsFrom the large US PharMetrics Patient-Centric Database, patients aged 20-89 with at least 2 claims for a diagnosis of gout (ICD9 274.xx) and related prescriptions between January 1, 1996 and December 31, 2008 were included. Gout flares were ascertained during follow-up. Sex-specific multivariable Poisson regression models were used to assess factors associated with number of flares.Results177,637 gout patients were included (mean age 55.2 years; men 75.6%). Overall, more than half (58.1%) had any of the considered comorbidities; hypertension (36.1%), dyslipidemia (27.0%) and diabetes (15.1%) being the most common. Nonselective NSAIDs were the most commonly dispensed (in 38.7% of patients). Notably, 39% of patients did not receive any prescription medication for gout. Patients with comorbidities were significantly more likely to receive anti-gout prescriptions. During an acute episode the prescription of NSAIDs and colchicine increased; and 29.9% of patients received allopurinol. The risk of flares was associated with cardiometabolic comorbidities and older age in women (highest at age 60-69), while in men it decreased by age. Women with these conditions were 60% more likely to have flares (incidence rate ratio, IRR 1.60;1.48-1.74), while men were 10% (IRR 1.10; 1.06-1.13) more likely.ConclusionsComorbidities affected gout treatment patterns and the occurrence and frequency of acute attacks. Cardiometabolic comorbidities, common in this patients' population, were associated with an increased risk of flares.

Comparison of general practitioners and rheumatologists' prescription patterns for patients with knee osteoarthritis

BackgroundTo compare the prescription modalities of general practitioners (GPs) and rheumatologists (RHs) for symptomatic knee osteoarthritis (OA) and to determine correlates with prescription of low-dose NSAIDs.MethodsThis observational, prospective, national survey was carried out among a national representative sample of GPs (n = 808) and RHs (n = 134). Each physician completed a medical questionnaire for the 2 most recent patients fulfilling the ACR criteria for knee OA.ResultsGPs and RHs included 1,570 and 251 patients, respectively. Mean pain level of the knee (on a VAS, 0-100 mm) was greater for GP patients than for RH patients (49.8 ± 16.3 vs. 46.2 ± 17.1 mm, respectively; p < 0.01). As compared with patients of RHs, those of GPs more frequently had another joint affected by OA: 71.2% vs. 63.7% (p < 0.0001) and more often had hypertension and diabetes mellitus (p < 0.05).As compared with RHs, GPs more frequently prescribed low-dose NSAIDs (p < 0.0001), oral NSAIDs (p < 0.05), and topical NSAIDs (p < 0.0001) but less frequently symptomatic slow-acting drugs for OA (p < 0.01). Moreover, GPs more frequently recommended rehabilitation (p < 0.01) and loss of weight (p < 0.0001). Logistic regression analysis revealed an association of low-dose NSAIDs prescription and prescription by GPs, prescription of topical NSAIDs, no prescription of oral NSAIDs or coxibs and no intra-articular injection of steroids.ConclusionsThis study identified speciality-related variability in some aspects of the management of knee OA. The clinical profile of patients with knee OA differed between GPs and RHs.

Trends in gastrointestinal bleeding in the Region of Valencia (2000-2005). Relationship to sales of nonsteroidal anti-inflammatory drugs and acid suppression medication

Objective To describe 2000-2005 time trends of prescription for NSAIDs, proton pump inhibitors (PPIs) and hospital admissions for gastrointestinal (GI) bleeding. Methods Time series analysis of gastrointestinal (GI) bleeding admission and drugs’ Defined Daily Dose per 1000 people per day (DDD/1000/day) in the Region of Valencia, Spain, from January 2000 to December 2005. Results Dispensation of NSAIDs went from 42.7 DDD/1000 people/day in 2000 to 58.3 DDD/1000 people/day in 2005. During the same period, dispensation of PPIs went from 26.3 DDD/1000 people/day to 68.5 DDD/1000 people/day (both are statistically significant). The rate of hospitalisations for gastrointestinal bleeding during this period oscillated between 142 and 126 admission per 100 000 inhabitants/year. No year showed significant differences compared to 2000. Conclusion A substantial increase in the NSAID use from 2000 to 2005 was not accompanied by changes in GI bleeding hospitalisation rates in Valencia, but GI bleeding rates continued to be high, suggesting a need to improve NSAIDs use.

Dose Variations Associated with Formulations of NSAID Prescriptions for Children

NSAIDs, particularly ibuprofen, are commonly prescribed for children but there is limited published research on real-life prescribed doses for this class of drugs. The aim of the study was to investigate if variations in NSAID doses prescribed to children can be explained by patient age, indication, dosage form, type of NSAID or year of prescription. Recorded daily doses for drugs within the 'Anti-rheumatics, non-steroidal plain' anatomical classification were studied. First prescriptions of a distinct NSAID substance within 13-month time periods in a patient's history were included. To enable grouping and comparison of NSAIDs, doses were analysed as prescribed daily doses (PDDs) relative to the adult defined daily dose, stated as the relative PDD (rPDD) in this study. Multiple regression analysis was performed with the rPDD as the response variable, and age, indication, dosage form, NSAID substance and year of prescription as the explanatory variables. Prescriptions from the Intercontinental Medical Statistics (IMS) Health Disease Analyzer database containing electronic health records of general practitioners in the UK issued from 1988 to December 2005. Data for children aged 2-11 years with NSAID prescriptions including daily dose information. A total of 21 473 first prescriptions for 19 695 patients were studied. The vast majority of prescriptions were for ibuprofen (n = 20 855), which were therefore analysed separately. The other NSAID prescriptions were grouped (n = 618), containing diclofenac, indometacin, mefenamic acid, naproxen and piroxicam ('NSAID group'). The rPDD varied considerably with dosage form in both the ibuprofen and NSAID groups. In particular, tablets/capsules were prescribed at higher doses than liquid dosage forms. In the NSAID group, naproxen was prescribed at noticeably higher doses. The rPDD varied only slightly with age in both groups. Prescriptions indicated for rheumatic disease were associated with lower doses than other indications in the NSAID group. The rPDD was not influenced by year of prescription. This study shows a correlation between higher prescribed NSAID doses and tablet/capsule formulation, and highlights the need for careful choice of dose formulation when prescribing medicines for children.

OTC NSAID use more common than prescription NSAIDs?

OTC NSAID use more common than prescription NSAIDs?